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Family Health Magazine
DENTAL HEALTH

Headaches
Can your dentist make them go away?

If you wake up in the morning with a dull headache around your temples, it may be the result of a jaw disorder and grinding your teeth while asleep. If this is the case, your dentist can help.

Clenching and grinding the teeth for no apparent reason is called bruxism. If you do it while awake, it is somewhat under your control. However, sleep bruxism (SB) can be more difficult to manage. SB affects about eight percent of adults and tends to decrease with age. It affects men and women equally.

Although SB is not completely understood, it is believed to have many factors. The body’s nervous system, stress and anxiety may all play a role. Research has shown that it is related to partial awakening and tooth contact during sleep. Tooth contact is the last event that happens after a sequence of responses in the body, including brain and heart rate activation.

True diagnosis of SB can only be made through hospital sleep studies. Unfortunately, sleep studies are complex, time-consuming and expensive. Instead, a specially trained dentist can help diagnose this condition by asking certain questions.

Most adults occasionally experience headaches. Cluster, various forms of migraine and tension headaches are all types that can be related to sleep. Sleep disorders associated with headache include sleep apnea, insomnia, periodic limb movement (PLM) disorder, upper airway resistance sydrome (UARS) and sleep bruxism.

Currently, only a small amount of scientific evidence shows a relationship between SB and headache pain. However, this research suggests that most people with bruxism also experience headaches.

Tension headaches related to sleep usually appear upon awakening. Contracting muscles cause pain, usually in the temple and forehead. Sleep disorders involving breathing, flailing limbs, insomnia or teeth grinding can be related to these headaches. Jaw muscle and joint disorders may also be involved.

Sleep bruxism is one possible cause of tension headaches in the temple area. The head is stiff or dully aching when waking in the morning. Pain typically recedes as the day goes on. Morning headaches due to SB may feel like soreness from exercising muscles in the temple area.

Headache pain related to SB needs to be distinguished from other headaches related to sleep, including cluster headaches and some migraines. With all these types of head pain, people wake in the middle of the night with pain and tension in the face and skull area. Other conditions, including fibromyalgia, can have a similar effect.

Table 1 - Diagnosting Pain that Interferes with Sleep

Managing sleep bruxism

• Dental appliances such as a hard acrylic oral splint, similar to a mouth guard, for the lower or upper jaw may be used.
• Strategies including biofeedback, relaxation, and education may help those with sleep bruxism learn to relax the jaw.
• The effect of medication is being studied.

Dental approaches

Soft vinyl mouth guards and hard acrylic occlusal splint appliances are very helpful in managing mouth and face pain and protecting teeth. Soft mouth guards are not as useful for this purpose. Studies have found that over half of patients with soft mouth guards show increased jaw muscle activity during sleep. A hard acrylic occlusal splint, similar to a mouth guard, is most suitable. These appliances cut down on activity by the chewing muscles and frequency of tooth grinding during sleep.

Strategies involving thought and behavior

Biofeedback training (learning to control normally unconscious body functions) is thought to help in treating SB. Unfortunately, the effect does not last once treatment stops. Stress management or lifestyle changes may assist those who are feeling stress or anxiety. A dental specialist or another health care professional can explain possible links between SB and life stress. Using relaxation strategies, people with SB can learn to control their mouth movement in response to life events. For instance, abdominal breathing exercises may be useful.

Sleep hygiene education may also help. Patients can learn to:

• use relaxation methods
• avoid intense mental or physical activity in the evening
• stay away from alcohol, caffeine, and tobacco close to bedtime
• create a comfortable sleeping environment, with good ventilation and a comfortable bed.

However, the success of managing SB this way remains to be proven.

Medication

Currently, no effective medication exists to treat SB. Although several drugs have been suggested, their effects are not fully convincing and they are not recommended long-term. More research is needed in this area.

If you find morning tension headaches are causing a problem, discuss them with your family doctor or dentist. There may be a solution.